Department of General Surgery, Affiliated Hospital of North Sichuan Medical College, Nanchong, China; Institute of Hepato-Biliary-Pancreas and Intestinal Disease, North Sichuan Medical College, Nanchong, China.
Department of General Surgery, Affiliated Hospital of North Sichuan Medical College, Nanchong, China; Institute of Hepato-Biliary-Pancreas and Intestinal Disease, North Sichuan Medical College, Nanchong, China; Department of Hepatobiliary Surgery, Chinese People's Liberation Army General Hospital, Beijing, China.
Clin Gastroenterol Hepatol. 2014 Mar;12(3):394-402.e1. doi: 10.1016/j.cgh.2013.09.023. Epub 2013 Sep 25.
BACKGROUND & AIMS: Little is known about outcomes of patients with nonalcoholic steatohepatitis (NASH) who receive liver transplants. We performed a systematic review and meta-analysis to estimate post-transplant outcomes, survival times, and mortality from cardiovascular complications, sepsis, and graft failure in these patients.
We searched PubMed and EMBASE, and Cochrane library and Web of Science databases for studies published through September 1, 2012 of patients who underwent liver transplantation for NASH or nonalcoholic fatty liver disease (NAFLD). All original studies from single institutions that reported outcomes of patients with or without NASH after liver transplantation were considered. Odds ratios (ORs) were calculated for patients with NASH, compared with patients without NASH; 95% confidence intervals (CIs) were calculated.
Our final analysis included 9 publications, on 717 patients with NASH and 3520 without, all of whom underwent liver transplantation. Similar proportions of patients with and without NASH who received liver transplants survived for 1, 3, and 5 years (OR for survival of patient with NASH 1 year after liver transplantation, 0.77; 95% CI, 0.59-1.00; P = .05; OR 3 years after transplantation, 0.97; 95% CI, 0.67-1.40; P = .86; OR 5 years after transplantation, 1.09; 95% CI, 0.77-1.56; P = .63). Patients with NASH had a greater risk of death from cardiovascular complications after liver transplantation (OR, 1.65; 95% CI, 1.01-2.70; P = .05) and from sepsis (OR, 1.71; 95% CI, 1.17-2.50; P = .006). However, patients with NASH were at lower risk of graft failure compared with patients without NASH (OR, 0.21; 95% CI, 0.05-0.89; P = .03).
Similar proportions of patients with and without NASH survive for 1, 3, and 5 years after liver transplantation. However, patients with NASH are more likely to die from cardiovascular complications or sepsis. More attention and careful consideration are therefore required in selecting patients with NASH for liver transplantation, along with aggressive management of cardiovascular complications and sepsis after transplantation.
对于接受肝移植的非酒精性脂肪性肝炎（NASH）患者，其术后结局、生存时间以及心血管并发症、脓毒症和移植失败的死亡率情况尚不清楚。我们进行了一项系统评价和荟萃分析，旨在评估这些患者的移植后结局、生存时间，以及心血管并发症、脓毒症和移植失败导致的死亡率。
我们检索了PubMed、EMBASE、Cochrane 图书馆和 Web of Science 数据库，以获取截至 2012 年 9 月 1 日发表的关于因 NASH 或非酒精性脂肪性肝病（NAFLD）接受肝移植的患者的研究。纳入所有来自单一机构的、报道了 NASH 患者和非 NASH 患者肝移植后结局的原始研究。计算 NASH 患者与非 NASH 患者的比值比（OR），计算 95%置信区间（CI）。
我们最终的分析纳入了 9 项研究，共涉及 717 例 NASH 患者和 3520 例非 NASH 患者，所有患者均接受了肝移植。接受肝移植的 NASH 患者和非 NASH 患者在 1、3 和 5 年时的生存率相似（肝移植后 1 年 NASH 患者的生存率 OR，0.77；95%CI，0.59-1.00；P=0.05；移植后 3 年的 OR，0.97；95%CI，0.67-1.40；P=0.86；移植后 5 年的 OR，1.09；95%CI，0.77-1.56；P=0.63）。NASH 患者发生心血管并发症相关死亡的风险更高（OR，1.65；95%CI，1.01-2.70；P=0.05）和脓毒症（OR，1.71；95%CI，1.17-2.50；P=0.006）。然而，与非 NASH 患者相比，NASH 患者发生移植失败的风险更低（OR，0.21；95%CI，0.05-0.89；P=0.03）。
接受肝移植的 NASH 患者和非 NASH 患者在 1、3 和 5 年时的生存率相似。然而，NASH 患者发生心血管并发症相关死亡或脓毒症的风险更高。因此，在为 NASH 患者选择肝移植时，需要更加关注和慎重考虑，并在移植后积极管理心血管并发症和脓毒症。
